- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.53 / $2,955.00 / $7,203.00
| Facility | | $1,859.53 | $2,955.00 | $7,203.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,854.59 / $2,046.71 / $3,538.12
| Professional | | $1,854.59 | $2,046.71 | $3,538.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,280.53 / $6,078.00 / $28,594.87
| Facility | | $2,280.53 | $6,078.00 | $28,594.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,940.39 / $3,351.30 / $14,475.96
| Professional | | $1,940.39 | $3,351.30 | $14,475.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,068.48 / $3,208.74 / $5,879.05
| Professional | | $2,068.48 | $3,208.74 | $5,879.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,909.00 / $3,056.97 / $8,090.00
| Facility | | $1,909.00 | $3,056.97 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,324.46 / $2,815.68 / $3,843.05
| Professional | | $2,324.46 | $2,815.68 | $3,843.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,591.13 / $5,073.43 / $6,604.79
| Professional | | $2,591.13 | $5,073.43 | $6,604.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,931.75 / $1,931.75 / $1,931.75
| Facility | | $1,931.75 | $1,931.75 | $1,931.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.21 / $392.21 / $392.21
| Professional | | $392.21 | $392.21 | $392.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $21,653.39
| Facility | | $2,386.00 | $5,904.00 | $21,653.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,036.10 / $3,657.10 / $14,475.96
| Professional | | $2,036.10 | $3,657.10 | $14,475.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.63 / $2,893.28 / $5,920.63
| Professional | | $1,991.63 | $2,893.28 | $5,920.63 |